Evaluation of leakage resistance improvement in transconjunctival sutureless vitrectomy sclerotomies closed with adhesives. an experimental study

Lorenzo López-Guajardo,Juan Donate-López,Valeria Opazo-Toro,Javier Benítez-Herreros

doi:10.1038/s41433-019-0651-4

Abstract

BackgroundThe purpose of this paper is to study the utility of adhesives (artificial-cyanoacrylate and biological-fibrin glue) for improving transconjunctival sutureless vitrectomy (TSV) sclerotomy closure competency.MethodsExperimental and observer-masked study in which after performing TSV in cadaveric pig eyes, different adhesives were tested on sclerotomy entrances in order to determine if they improved closure competency in face of progressive intraocular pressure increase. In 76 eyes cyanoacrylate-treated sclerotomies were compared with sclerotomies in which no additional manoeuvre to aid closing was performed; in 76 eyes fibrin glue with no manoeuvre; and in the last 76 eyes, cyanoacrylate-treated sclerotomies were compared with fibrin glue-treated sclerotomies.ResultsA total of 228 eyes had a 23-gauge TSV performed. Both cyanoacrylate and fibrin glue treated sclerotomies achieved higher mean opening pressures when compared with nontreated sclerotomies in the same eye (p < 0.002). When cyanoacrylate was compared with biological adhesive in the same eye, no statistically significant differences were obtained (p = 0.216).DiscussionsThis experimental study provides support for the possible role of adhesives in improving TSV sclerotomy closure competency in clinical practice.

Highlights

Vitrectomy is one of the most frequently performed ophthalmic surgical procedures
When we analysed the sample of 76 randomly chosen eyes in which cyanoacrylate was applied on one of the superior sclerotomies and no additional closure manoeuvre was performed on the other incision, in 26 of them (34.2%; 95% CI: 24.0–46.1%) the sclerotomy sealed with cyanoacrylate opened first when IOP was increased (p = 0.001; Chi-Square test); when we studied the IOP values, treated sclerotomies opened at a significantly higher pressure level than nontreated incisions (p < 0.001; Mann–Whitney U test)
When we evaluated the 76 globes in which cyanoacrylate or biological glue were applied on superior incisions, 42 of the leaking wounds (55.3%; 95% CI: 43.5–66.5%) were the ones treated with biological glue (p = 0.256; Chi-Square test); no statistically differences were found when we analysed IOP levels in which sclerotomies opened (p = 0.216; Mann–Whitney U test)

Summary

Introduction

Vitrectomy is one of the most frequently performed ophthalmic surgical procedures (excluding cataract surgery). The use of adhesives, as an alternative to commonly used sutures for achieving correct sclerotomy closure, can be more adequate in settings such as thin or staphylomatous scleras or reoperated eyes with same sclerotomy localization; and can diminish postoperative astigmatism and patient discomfort Both biological (fibrin sealant) and artificial (cyanoacrylate) tissue adhesives were tested in this study. The purpose of this paper is to study the utility of adhesives (artificial-cyanoacrylate and biological-fibrin glue) for improving transconjunctival sutureless vitrectomy (TSV) sclerotomy closure competency. When cyanoacrylate was compared with biological adhesive in the same eye, no statistically significant differences were obtained (p = 0.216) Discussions This experimental study provides support for the possible role of adhesives in improving TSV sclerotomy closure competency in clinical practice

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